PATCHS PROGRAM PUBLIC HEALTH NURSING ADVOCATES TEACHING CHILD HEALTH AND SAFETY HEALTH CARE PROGRAM FOR CHILDREN IN FOSTER CARE (HCPCFC)
Volume 1, Issue 3		OCTOBER 2001

Medical Information Fact Sheet

Tuberculosis:

Tuberculosis (TB) is a chronic bacterial infection that attacks the lungs and causes them to deteriorate. Although TB commonly affects the lungs it can affect other parts of the body including the central nervous system, musculoskeletal system, lymphatic system and the urinary tract. If TB is not treated it can be fatal.

Causes:

TB is caused by the bacterium Mycobacterium tuberculosis. If a person with active TB coughs or sneezes near you, there is a chance you may inhale the microscopic TB bacteria. TB is not easily spread. Infection usually requires repeated exposures. TB spreads more easily in cramped, enclosed and poorly ventilated spaces where the chance of repeated exposure is greater.

If you become infected with TB, you won't necessarily develop the active disease. If your immune system is healthy, it will produce antibodies that wall off the bacteria. But the organism remains dormant, and if your immune system is weakened, the bacteria may overcome your body's defenses.

Signs and Symptoms:

• Minor cough or cough that produces discolored or bloody sputum
• Slight fever
• Fatigue
• Loss of appetite and weight
• Night Sweats
• Pain with breathing (pleurisy) or coughing, pain in the spine or large joints.

Your immune system tries to surround the TB germs with special cells called granulomas. If your body can't control the TB bacteria then the bacteria can multiply and the granulomas enlarge and become tumorlike masses in your lungs. As the disease progresses more of the lung tissue is destroyed and the granulomas expand and may liquefy. Eventually, cavities may form in your lungs and the bacteria may grow in these cavities and spread to other parts of your body.

Risk Factors:

• Lowered immunity to infections
• Poverty, homelessness and drug abuse
• Age
• Malnutrition
• Health care work
• International travel

Screening & Diagnosis:

• Skin test. A widely used skin test called a purified protein derivative (PPD) is used to determine exposure to TB. A small amount of fluid (tuberculin) is injected under your skin. Your reaction after 72 hours can indicate a presence of TB bacteria. A positive skin test does not mean you have active TB. If you once had a negative test and than had a positive test your doctor may want to treat you for a period of time.
• Chest X-ray. If you had a positive skin test, your doctor may order a chest x-ray to look for possible asymptomatic infection. Imaging may reveal white spots (granulomas) where your immune system has walled off the bacteria. Nodules or cavities may appear as well as pneumonia or fluid around the lungs.
• Culture tests. If an x-ray reveals a nodule or abnormal tissue that might represent tuberculosis or a fungal infection that can mimic tuberculosis, your doctor may want tissue or fluid samples. Samples of sputum from the lungs, urine and stomach secretions may be taken and examined for the presence of TB bacteria. Culturing TB organisms allows them to be tested for sensitivity to the usual medications.

Treatment:

Drugs offer the most effective treatment for TB. But successful drug therapy may require taking two to four medications for 6-12 months to completely destroy the TB bacteria. Treatment commonly starts with taking four drugs - isoniazid, rifampin, ethambutol and pyrazinamide. To decide which drug to continue taking cultures may be taken to determine drug sensitivity or resistance to each drug. When the results are known within 6-8 weeks, ineffective drugs may be replaced with other drugs or treatment may continue with less than four drugs. Although TB is no longer contagious after a few weeks of treatment, a full course of therapy is needed to kill all the bacteria. Failure to properly complete the treatment can create drug resistant strains of the disease that may render treatment ineffective. This development may cause TB to progress to a potentially lethal stage and may cause spread of the disease to others.

Prevention:

The best defense against TB is to avoid contact with someone who has active TB. If you are at high risk get a skin test every 6 months. Some individuals are given Isoniazid (INH) if they have a positive skin test and a negative chest x-ray as a preventative measure. There is an older vaccine, BCG, available and has some benefit in preventing TB. It is not widely used in the US and is more often given in countries where TB is common.

Watch for sneezing and coughing from an infected individual.

Mayo Clinic Health Information (2001), Tuberculosis

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Hepatitis:

Hepatitis means inflammation of the liver. Many things can cause the inflammation including: Toxic chemicals like phosphorous and gold, drugs like antibiotics, alcoholism and viruses.

We will focus on viral hepatitis. There are five types of viral Hepatitis, types A, B, C, D, & E.

Hepatitis A:

The Hepatitis A virus (HAV) causes Hepatitis A. Hepatitis A is transmitted through fecal-oral route, primarily through ingesting food or liquids infected with the virus. HAV is found in the stools of someone with Hepatitis A. Hepatitis A can be prevented by good personal hygiene and proper sanitation. Washing your hands with soap and water after using the bathroom and before preparing foods is a way to prevent Hepatitis A.

There is a vaccine against Hepatitis A that is very effective and is the best protection against the virus. Signs & Symptoms: Jaundice (yellowing of the skin) Fatigue Abdominal pain Loss of appetite Nausea Diarrhea Fever

There is a vaccine against Hepatitis A that is very effective and is the best protection against the virus.

Signs & Symptoms:

• Jaundice (yellowing of the skin)
• Fatigue
• Abdominal pain
• Loss of appetite
• Nausea
• Diarrhea
• Fever

There are no long term or chronic effects associated with Hepatitis A. Once you have had it you will not get it again.

Hepatitis B:

Hepatitis B is a serious disease caused by the Hepatitis B virus (HBV). HBV can cause lifelong infection, cirrhosis (scarring) of the liver, liver cancer, liver failure and death. HBV is transmitted when blood or body fluids of an infected person enter the body of a person who is not immune. HBV is spread by sexual intercourse, sharing needles, needlesticks from an infected person. It can also be passed to baby during birth if the mother is infected.

Signs & symptoms: Jaundice (yellowing of the skin) Fatigue Abdominal pain Loss of appetite Nausea, vomiting Joint pain

 

The best way to prevent Hepatitis B is through a vaccine. Other modes of prevention include: having protected sex, not sharing needles, not sharing personal items (like a razor), and beware of tattooing and body piercing. If you are a health care worker you should be vaccinated and practice barrier precautions. Infected individuals should have regular check ups to monitor for liver disease. There are a few medications for those with chronic hepatitis, but it is effective only 40% of the time.

Hepatitis C:

Hepatitis C virus (HCV) causes Hepatitis C. A person may be at risk for Hepatitis C if they:

• Were notified that you received blood from a donor who later tested positive for Hepatitis C
• Have injected illegal drugs
• Received a blood transfusion or solid organ transplant before July 1992
• Received blood products for clotting problems produced before 1987
• Have ever been on long term kidney dialysis
• Have evidence of liver disease.

75%-85% of those infected will have a chronic infection. 70% of infected individuals will develop long term liver disease. HCV is the leading indication for liver transplant.

Signs & Symptoms:

80% will show no signs & symptoms. Jaundice (yellowing of the skin) Fatigue Dark urine Abdominal pain Loss of appetite Nausea

 

There is no vaccine to protect against Hepatitis C. Methods to prevent hepatitis C include:

• Not sharing needles
• Careful to avoid needlesticks
• Do not share razors
• Be careful when getting tattoos and piercing
• Practice safe sex. (It is rare for HCV to be spread this way but it can be).

Hepatitis D:

Hepatitis D can only occur in individuals who are infected with Hepatitis B. The symptoms of hepatitis D are similar to those of Hepatitis B except that patients are more likely to develop Fulminant Hepatitis and to progress to chronic active Hepatitis and Cirrhosis.

Hepatitis E:

Hepatitis E is caused by the Hepatitis E virus (HEV). Hepatitis E is transmitted primarily by fecal-oral route. The most common mode of transmission is through fecally contaminated drinking water. Unlike Hepatitis A, person to person transmission of HEV is uncommon.

Prevention includes avoid drinking water (and beverages with ice) of unknown purity, uncooked shellfish and uncooked fruit and vegetables (not prepared by you).

There currently is no vaccine.

Smeltzer, S., & Bare, B. (1997). Brunner & Suddarth's Medical-Surgical Nursing. (8th ed.). Philadelphia: Lippincott.

 

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HCPCFC PROGRAM UPDATES and ANNOUNCEMENTS!!! We would like to congratulate Will Chavez on his promotion to Senior Public Health Nurse. Will was a PHN for the PATCHS program in Banning. He is currently working at Kidd St. as the new Senior PHN for the PATCHS program. We would also like to congratulate him on his recent Masters in Business Administration from the University of La Verne. Congratulations Will!!!!!!

 

Editor: Kristen Thompson, PHN,Contributors: Hermia Parks, SPHN, MA, and Judy Earp, MHA, Director of Public Health Nursing.